toms. Diverticular disease tends to have a more
intense course in people who are under age 50 at
the time of diagnosis.
Symptoms and Diagnostic Path
Diverticulosis often presents mild and vague
symptoms such as intermittent lower abdominal
discomfort or shows up incidentally on diagnostic
testing for other reasons. Large or multiple diver-
ticula may cause intestinal bleeding that may
appear as darkened stools or obvious bleeding
with bowel movements. Localized PAIN, especially
REBOUND TENDERNESS, and FEVERsuggest diverticuli-
tis though also are symptoms of APPENDICITIS.
The diagnostic path may include DIGITAL RECTAL
EXAMINATION(DRE), FECAL OCCULT BLOOD TEST(FOBT)
to check for microscopic bleeding, abdominal X-
ray, BARIUM ENEMA, and sigmoidoscopy or
COLONOSCOPY. These procedures help distinguish
between diverticulitis and appendicitis though
sometimes the distinction is difficult. Diverticula
often are apparent though barium enema and
either sigmoidoscopy or colonoscopy provides
definitive diagnosis. Occasionally the doctor may
request COMPUTED TOMOGRAPHY(CT) SCANor MAG-
NETIC RESONANCE IMAGING(MRI) to obtain detailed
information on the extent of the condition or to
identify a surgical emergency such as ABSCESSor
PERITONITIS.
SYMPTOMS OF DIVERTICULAR DISEASE
Diverticulosis Diverticulitis
painless rectal bleeding pronounced and localized
ABDOMINAL PAIN
ABDOMINAL DISTENTIONor
rigidity
FEVER
Treatment Options and OutlookDiverticulitis requires treatment with ANTIBIOTIC
MEDICATIONSto eradicate theINFECTION and calm
the INFLAMMATION. Oral antibiotics successfully
treat many people; widespread or deep infection
may require intravenous antibiotics or even surgi-
cal intervention to drain the infection and remove
any portions of damaged bowel. Untreated diverti-
culitis can result in abscess or peritonitis, which
are life-threatening complications. Other compli-
cations include intestinal obstructions and fistulas
(areas where the bowel erodes and establishes an
opening into another structure such as the BLAD-
DER or the VAGINA. These complications require
surgical repair; a complete intestinal obstruction is
an emergency.
Diverticulosis with no symptoms does not
require treatment. Because diverticulosis is so
prevalent among people age 50 and older, many
gastroenterologists consider it nonpathologic (not
a threat to health). Dietary measures such as
increased fiber consumption may be enough to
relieve mild symptoms such as occasional abdomi-
nal discomfort. It is important to determine the
source of any intestinal bleeding, and to undergo
regular COLORECTAL CANCER screening such as
FOBT, sigmoidoscopy, or COLONOSCOPY. The gas-
troenterologist should evaluate any changes in
bowel habits, persistent abdominal distention, or
other circumstances that could suggest a different
diagnosis.Risk Factors and Preventive Measures
The primary risk factor for diverticulosis appears
to be aging. Doctors commonly detect diverticula
that do not cause symptoms in people who have
gastrointestinal imaging procedures done for other
reasons. People who are aware they have divertic-
ulosis should try to maintain eating habits that
support good gastrointestinal health, making sure
they consume enough dietary fiber and water.
See also AGING, GASTROINTESTINAL CHANGES THAT
OCCUR WITH; BOWEL MOVEMENT; GASTROINTESTINAL
BLEEDING; ILEUS; PELVIC INFLAMMATORY DISEASE(PID);
PROCTITIS.duodenum The first segment of the SMALL INTES-
TINE, which receives partially digested and lique-
fied food (called chyme) from the STOMACH. The
commonBILEduct ends in the duodenum, chan-
neling bile from the GALLBLADDER to the small
intestine. Much of the activity of digestion takes
place in the duodenum, where an abundance of
DIGESTIVE ENZYMEScombines with the bile to further
break down food particles into their core nutrient
molecules. Digestive content that leaves the duo-
denum for its journey through the remainder of
the intestinal tract is almost watery because of the
added digestive fluids. The remaining segments of
the small intestine, the ILEUMand the JEJUNUM,36 The Gastrointestinal System